DESCRIPTION: (Applicant's Description) First-degree relatives of breast cancer victims are at two-to ten-fold increased risk for developing the disease compared to women in the general population. Molecular testing may soon be able to identify which first-degree relatives (FDRs) are at heightened genetic risk. Risk identification should trigger earlier screening and/or primary prevention to ultimately decrease breast cancer morbidity and mortality. However, there are no well developed protocols for promoting FDRs' risk understanding, health-protecting behaviors, and psychological adjustment. Which FDRs' are likely to opt for genetic counseling and how to best achieve positive psychological and behavioral outcomes among those receiving counseling are unknown. A prospective study on a cohort of 200 FDRs referred by breast cancer patients from the Washington University Barnard Cancer Center is proposed. This is accomplished by: (1) baseline telephone interview assessing personal risk perceptions (and underlying reasons), psychological characteristics, and practice of breast cancer screening, (2) opportunity to participate in Genetic Risk Assessment Counseling conducted by a professional genetic counselor, and (3) one-year follow-up telephone interview to assess behavioral and psychological outcomes between counseling participants and nonparticipants. We will compare outcomes including between-group difference in those who do and do not choose to participate in Genetic Risk Assessment Counseling offered through the study, and within-group differences in psychological and behavioral outcomes among counseling participants and nonparticipants. The project will produce a counseling protocol for FDRs, describe this at-risk population, predict which FDRs will participate in Genetic Risk Assessment Counseling when offered, and determine the influence of baseline characteristics on post-counseling outcomes. Participation choices and outcomes associated with risk counseling, once better understood, can guide the emerging field of Genetic Risk Assessment Counseling for breast cancer by determining how counseling should be tailored for FDRs with different perceptions and characteristics. Findings from this study are required to design an effective mechanism for counseling FDRs who need to understand their risk status and options for avoiding breast cancer mortality.